Spring 2023 Department of Primary Care & Public Health
April 2023 I am very pleased to welcome Dr Ana Neves to the department as our new Senior Lecturer in Digital Health and Director of the Global Health Digital Unit. Digital technologies will play a key role in healthcare globally. Our work in digital health is already having national impact; such as the evaluation of the NHS App. I am also very pleased to hear from Professor Jennifer Quint in this edition of the newsletter and learn more about her work and her background. We are sad to lose Professor Josip Car who is leaving Imperial College to take up the role of Head of the School of Life Course and Population Sciences at King’s College London. This is a very senior Professor Azeem Majeed academic appointment and shows how much Josip has progressed in his Head of Department of Primary Care and academic career. Public Health Imperial College London Follow Prof Majeed on Twitter We welcome feedback on the newsletter ARCHIVE PRIVACY NOTICE and are taking submissions for future issues. Email your news, events, achievements and stories to us. PCPH eMagazine Production Team [email protected] Designed and edited by Javier Gallego Editorial Assistant – Mehrosa Memood Subscribe Unsubscribe Copyright © 2023 Department of Primary Care & Public Health, Imperial College London
SUPPORTING HEALTHCARE WORKERS Photo by Luis Villasmil on Unsplash WITH WORK RELATED STRESS AND BURNOUT A recent article in the British Medical Journal discusses work-related stress and burnout in healthcare workers. These are important problems in the NHS workforce in the UK as well as amongst healthcare workers in other countries. Addressing the underlying cause, which may relate to factors such as workplace demand, relationships, and support is necessary for sustained recovery and full engagement with work. Healthcare workers may experience guilt or shame due to stigma, preventing them from seeking help if they experience work related mental illness. Time off work and workplace changes to control the triggers may be necessary to allow recovery and sustainable return to work. Healthcare workers experiencing work related stress can seek support from colleagues, their own GP, occupational health, and specialised services for healthcare workers such as local mental health and wellbeing hubs and NHS Practitioner Health.
GLOBAL DIGITAL UNIT and adaptation throughout the implementation process, and how this Dr Ana Luisa Neves (Clinical Senior impacts the perception of intervention Lecturer in Digital Health and Director delivery and sustainability. She has of the Global Digital Health Unit) has over six years of experience in the been selected for the 2023 cohort of academic field as a lecturer at Imam the European Talent Academy, a Abdulrahman Bin Faisal University partnership between Imperial College, (IAU) in Saudi Arabia, teaching health the Technical University of Munich management and quality improvement (TUM) and Politecnico di Milano courses to undergraduate students, (PoliMi). This programme provides an and co-supervising undergraduate opportunity for emerging group research projects in health services leaders at Imperial, TUM and PoliMi to research. In 2022, she was presented meet across disciplines, to make with the IAU College of Public Health international research connections, Teaching Excellence Award. and to network with policymakers and other stakeholders connected to EU Husa graduated with a first-class research funding. honours bachelor’s degree in Health Information Management and In line with the program’s theme for Technology from IAU in 2013. She was 2022-23 (‘Striving for life-long health in then offered an academic position at Europe: Strategies and technologies the same university and was awarded for a healthier society’), Ana’s research a scholarship from the government of vision is to support the development, Saudi Arabia through IAU to continue evaluation, and diffusion of healthcare her postgraduate studies (Master and digital innovations, aiming to PhD). In 2015, she completed a sustainably reduce inequalities in master’s degree with distinction in health systems. Health Management, with a major in Quality and Patient Safety, at NHR ARC NWL INNOVATION & Queensland University of Technology, EVALUATION THEME Brisbane, Australia. Her research interests include the implementation Husa is a PhD student in the and evaluation of quality improvement Department of Primary Care and Public interventions, understanding what Health, working within the NIHR ARC shapes their successful NWL Innovation & Evaluation Theme. implementation and what makes them Her PhD focuses on exploring how work in one context and fail in healthcare quality improvement teams another. navigate the tension between fidelity
PRIMARY CARE MEDICAL EDUCATION touch if you are interested in collaborating! We are grateful to receive the ASME Education Innovation Award to WHO COLLABORATING CENTRE FOR develop immersive, 360 videos for PUBLIC HEALTH EDUCATION AND early year medical students. Using a TRAINING 360 camera, we will take advantage of the immersion and presence qualities The WHO Collaborating Centre for of 360 video to help students feel Education and Training is pleased to prepared for GP placements, as well as have welcomed three new discover how variations in Postgraduate Fellows to its team. Dr communication skills impact patient Samiya Al Khaldi from Oman, Dr Nasrin experience. We are keen to include Al Zadjali from Oman and Dr Joud three-way consultations (such as with Almutairi from Saudi Arabia joined the a language interpreter). We will also Centre in November 2022. They pursue make virtual tours of GP premises to their professional medical interests, as help students feel comfortable with well as research work during their time the GP environment. Please get in with the WHO CC. INNOVATION AND EVALUATION My name is Allison Williams, and I am originally from Florida, USA. There I studied Health Education and Behaviour, as well as Disabilities in Society, during undergraduate degree at the University of Florida (Go Gators!). While Florida will forever be my home, I have loved living in London over the past two years. Through completing my MPH here at Imperial, I was fortunate to work with team members from the PCPH department on my dissertation, and I am happy to continue working with the team as a Research Assistant. Though I have just started in this role recently, I have already learned so much about the current and future projects that I will have the opportunity to contribute to. One such project is the Community Health and Wellbeing Worker Initiative, which I look forward to leading aspects of the data analysis. It is gratifying to finally be able to apply what I have focused my academic career on to projects that provide actionable change for bettering the health of our communities, and I feel lucky to be a part of it. Most of all, I am very grateful for the warm welcome I have received from everyone in the department, and I am excited for all there is to learn from each of them!
Back in December 2020 Nursing to make their dream a Christmas was cancelled. We reality. Lindsay already had were just coming to grips with selected 9 young people from 70 having to be apart from our across the country to be part of a loved ones during the Christmas co-produced symposium and break - only being able to see after school events project and people within our immediate offered four of the nine another household or small bubble. But it opportunity to be part of the new was during this time that Lindsay film project. Four subsequently was headhunted by InnerEye joined the team, and along with Productions, a national film West London NHS Trust, Lindsay production company founded by and co set about making the film. Chris Godwin to make a film about her Covid research. For Lindsay’s research found that Lindsay, this was both an eating-related coping strategies exciting and daunting task but were one of the most common was thrilled at the chance to use ways young people coped during innovative and creative societal the first lockdown. Social engagement media to connection also came across communicate her research quite heavily in her qualitative findings. It was soon into the work as a protective factor conversation with Chris that against deteriorating mental Lindsay pushed for the need to health in young people. After work with young people with numerous discussions with the lived experience on the film team, eating disorders in men, project – not just ask their and power of social connection opinion once or twice – but to was chosen as the focus of the work with them in partnership film. The main character Matt all the way through the film goes through a lot in the film – he production process. This way of has an existing eating disorder working was very different to and is experiencing poverty how Chris usually worked, and to before the lockdown hits, but his their knowledge had not been experience is made worse with done before. the lack of connection or even digital connection with his They soon secured over £50,000 friends. Importantly, the young funding from West London NHS co-producers and team jointly Trust and the Burdett Trust for made these decisions. In fact,
decisions about the film’s
direction, script, scenes, locations, editing and Pelumi (Young Co-producer, even the actors were shared between Lindsay, Executive Producer), Lindsay Chris, clinicians, and the young co-producers. It (Advanced Research Fellow, was so important to Lindsay, and subsequently Film Producer), Dylan (Young Chris, that the young person’s voice was at the Co-producer, Executive heart of the film. Producer) and Chris (InnerEye Productions, Film Director) at Since Nexus wrapped in 2022, it has been Riverside Stadium, archived with the British Film Institute – which Middlesbrough Football Club in recognises it as a film of historical significance Teesside on the last in-person and has premiered with them in December screening of Nexus. 2022. Following this success, Lindsay and the team also took Nexus on the road during Eating Disorders Awareness Week 2023 (February 27 - March 2nd, 2023) in Birmingham, Manchester and Middlesbrough. Each event was chaired by the Royal College of Psychiatrists and was attended by 100 people. The online YouTube premiere was chaired by Agnes Ayton Chair of the Faculty of Eating Disorders, Royal College of Psychiatrists and was a huge success! Since the premiere Lindsay has been interviewed twice by BBC radio (BBC World Series and BBC West Midlands) and will be featured in RCPsych Insight magazine, and at the Great Exhibition Road Festival 2023. The team has also won more funding from the Burdett Trust for Nursing to reach out to more audiences. What next? Lindsay and the team are encouraged by the positive feedback so far and plan on using Nexus’ success to raise awareness of the importance of social connection, and eating disorders in men, and to start conversations with others about using film, and a creative co-produced approach to disseminate research findings to make an impact in policy and practice.
Watch the film Nexus The film has already attracted press with Lindsay and one of the young people involved in the project, Simi, being interviewed by BBC World Service. Listen to the interview
Our study published in the British Journal of General Practice shows how the uptake of flu vaccination in pregnancy varies with age, ethnicity and socio- economic deprivation. Pregnant women are at an increased risk from influenza (flu), yet uptake of Seasonal influenza vaccination (SIV) during pregnancy remains low, despite increases since 2010.
Getting the flu vaccine when Previous studies of influenza pregnant is important, because it vaccine uptake during pregnancy reduces the risk of severe have either used data from a disease, complications and single care provider, or from adverse outcomes for both surveys. Our retrospective cohort mother and child such as pre- study looked at 450,000 term birth. However, uptake was pregnancies among 260,000 lower among women living in women in North West London, more deprived areas, women over a ten-year period. By who were younger or older than applying statistical models to data average, Black women and those on women’s age, ethnicity, health with undocumented ethnicity. conditions and socio-economic Although the flu vaccine is safe deprivation, we were able to and recommended for pregnant identify groups with lower uptake women, misconceptions about of the flu vaccine. safety play a role in pregnant Misconceptions about the safety women not being vaccinated and and efficacy of antenatal flu vaccination levels among vaccinations play a role in pregnant women are suboptimal pregnant women being worldwide. unvaccinated, while In the UK, since 2010, the Joint recommendation by health Committee on Vaccination and professionals improves uptake. Immunisation (JCVI) has To ensure access to vaccines, for recommended that pregnant high uptake among pregnant women get the flu vaccine to women, strong primary care provide protection during the systems are needed, and targeted winter flu season. Despite these approaches are recommended to recommendations, data from reducing inequalities in access to Public Health England (now the vaccination and should focus on YK Health Security Agency) women of Black ethnicity, showed that in 2020-21, fewer younger and older women, and than half of pregnant women women living in deprived areas. were vaccinated. FURTHER READING Key steps in implementing the annual flu vaccination programme
Photo by Colin Maynard on Unsplash
The Promoting Health Equity Student Selected Component (SSC) provides space for third year medical students to consider how social factors and lived experience impact health, access to healthcare and health outcomes, and how they can apply this understanding in their career. After a session exploring health equity, students spend two sessions with local community organisations to encourage their understanding of the health priorities of different groups.
Hammersmith United Charities impact on health. We hope it is provide small grants for community helpful to understand potential ways initiatives and run almshouses. Here, that medical professionals can students toured the almshouses and collaborate with community met with residents at their weekly organisations for the benefit of their coffee morning, discussing what about patients. Our residents are always their health matters most to them. happy to speak to students about Urban Partnership Group runs a their experiences and answer any variety of community services. questions they may have.” Students visited their Edward Woods Victoria Hill – Chief Executive community centre to hear more about Hammersmith United Charities. their work and joined an Adult Education English class, discussing Creating space for students to visit health priorities and inclusive access community organisations has proven to healthcare for all patients useful for them to develop an regardless of their level of English. understanding of community priorities. Mosaic LGBT+ Young Persons’ Trust Reflecting on their experiences, supports young people in London who students identified areas they had not are part of the LGBT+ community previously considered, for example through a variety of initiatives, events how people may be concerned about and support. Here, a panel of calling for an appointment because of community members discussed their fears that their English is not “good experience of LGBTQ+ health and enough.” Others reflected on how answered questions from students. older adults might be just as agile and engaged at 90 as they were at 60 and The organisations involved are keen to that having a community around them engage the next generation of medical can help them avoid becoming isolated professionals, highlighting what really or lonely. Some students also matters to the communities they work suggested that clarifying pronouns with. Each session is co-created with could transform a consultation, them to ensure that they are mutually ensuring they were not making beneficial. assumptions which may affect patient care. “We are keen to engage medical students to shine a light on In their own words: “The community Almshouses and activities occurring in organisation visits were great! Learnt our community that have a positive so much.” This SSC runs every term for third year medical students. If you would like to know more or have any thoughts, reach out to Community Collaboration Lead Stephanie Powell.
A real change is on the horizon. In October 2021, Facebook announced that it would rebrand itself as ‘Meta’, and this generated high levels of public interest in the metaverse for the first time. Definitions for the metaverse vary and there is still much uncertainty in its eventual future manifestation. It is perhaps best defined as a fully immersive parallel digital reality where users will be able to interact at a scale previously unimagined.1 The advent of the metaverse could have transformational impact on every aspect of human life, from our social interactions to what we ascribe real value to. Just as the Internet has completely transformed health, the metaverse will redefine virtual and physical possibilities in health.2 This will have major implications for our health and for healthcare delivery. The coming of age of the metaverse is in due largely to the maturation of technological advances in artificial intelligence and devices that enable the delivery of mixed, augmented and virtual reality, along with cryptography, the catalyst behind web3, and increased computing power. Read the full article in the Journal of the Royal Society of Medicine.
Image by mohamed_hassan from Pixabay (colours altered)
Photo by amirali mirhashemian on Unsplash
Celebrating its 15th year of improving nutrition, prevention, and health through scientific research and strategic collaboration NNEdPro Global Institute for Food, Nutrition, and Health met with the WHO Collaborating Centre for Public Health Education and Training in January, to gain a scientific and strategic consensus on ultra- processed foods (UPFs) and precision nutrition that are reflected in publications and external communications.
ULTRA PROCESSED FOODS: ALL EVIL? The first part of the meeting focused on ultra-processed foods. Recent years have seen a growing body of literature linking the consumption of UPFs to specific health issues. However, there are also concerns about the simplicity and robustness of UPF classification methods and the quality of study designs used to investigate the relationship between UPF and health. Concerns have also been raised about the appropriateness of UPF classification, the poor quality of the information in some studies, and the need to consider the whole diet picture rather than demonizing individual foods. The challenges of conducting research on UPF, including the complexity of food technologies and the lack of long-term health data on certain food additives, have also been discussed. Dr Federica Amati, who represented choices. Dr Marie-Ann van Ginkel, both organisations, emphasized the Senior Lecturer in Nutrition at the need to focus on the quality of University of Brighton, suggested studies rather than solely relying on looking at how the food matrix is NOVA classifications. The NOVA broken down by processing in classification system is a set of various UPFs and creating different descriptive criteria that assign foods groups of foods based on processing to one of four groups: (1) level. From a public health unprocessed, (2) processed culinary perspective, Celine Tabche from ingredients, (3) processed foods, WHOCC, mentioned the importance and (4) UPF1. Prof. Eleanor Beck of clarity of messages to the public highlighted limitations of the NOVA to avoid an infodemic and the classification system, in that it dangers of demonising foods. The lumps nutritious and fortified foods, group later discussed the such as Weetabix, with processed affordability and accessibility of foods that contain little nutritional healthy, unprocessed foods, value, refined sugars and other especially in low-income and ingredients which may negatively isolated communities. A significant impact health in one group of UPF. emphasis was placed on the For instance, cheese serves as a importance of promoting the great example: while a great source consumption of healthy foods, such of potassium and calcium, it is as whole grains, as well as canned found in group three of processed and frozen fruits and vegetables, as foods (2). This conflation calls for a a more affordable alternative, as change in the system to help well as encouraging the food individuals make healthy eating industry to produce products with
Photo by Angel Sinigersky on Unsplash
Photo by VIRUL on Unsplash
fewer additives. Another important encourage companies to point came from Prof. Daniele Del reformulate their products, making Rio, who highlighted the dangers of them healthier for consumers. communication to the public Experts are committed to advancing around food additives (‘chemicals’) our understanding of the in UPFs. Moreover, Prof. Kathy relationship between UPF and Martin emphasized that in many health and promoting healthy whole instances, food additives make food foods. However, there is still much products that are safer to consume, work to be done to improve the more durable and accessible, and quality of research and classification are crucial to healthy eating in methods and to make healthy food various communities. Redefining more affordable and accessible for the classification of UPFs will help all. PRECISION NUTRITION FOR ALL? The session’s second portion discussed the concept of precision nutrition and its potential applications in health promotion and disease prevention. Currently, 1% of the population in the UK adheres to nutritional guidelines such as the Eatwell Guide (3). There was a consensus amongst the group that this highlights the need for targeted and personalized approaches to nutrition rather than blanket recommendations. Precision nutrition, under the using apps and at-home testing; umbrella of precision medicine, accessible and affordable, allowing seeks to improve the the field to grow; however, the personalization of the treatment of group emphasised the distinction disease through the consideration between personalized nutrition and of DNA, metabolism, health history, precision nutrition. The more and other factors (4,5). Personalized precision nutrition is applied, the nutrition pertains more to individual more data it will generate for nutritional requirements based on further development. Prof. Martin medical history. Both definitions Kohlmeier, from the University of focus on the individual rather than North Carolina, emphasized that the population. Dr Amati started the specific dietary treatments based on discussion by stressing the genetic data have been used for usefulness of personalized nutrition years, for instance for for one-on-one work. She also Phenylketonuria (PKU). Other stated that it can be made universal, members of the group, including
Prof. Sumantra Ray, Prof. Marisa removes the generalization to a Papaluca, and Prof. Del Rio were population level. One example is an concerned about the risks of individual with poor glucose control, implementing personalized for whom potatoes shouldn’t be nutrition approaches too quickly. their most consumed vegetable. There is a need for checks and With precision tools in a balances for GPs as well as personalized stage, people are more nutritional apps. The work likely to engage, as they can see surrounding genetics is still in its how it alters the pattern of their early development; thus, collecting metrics. The more extensive data and providing advice implementation of personalized simultaneously could pose risks. precision nutrition allows the Besides the concerns, however, recognition that not everybody precision nutrition also offers responds to a particular nutritional opportunities to engage people in input the same way. making better dietary choices as it The NNEdPro Global Institute for Food, Nutrition and Health and WHOCC had productive and aligning discussions around concerns and challenges surrounding UPF classification methods and precision nutrition, emphasizing the need for promoting healthy, whole foods and targeted, personalized approaches to nutrition. They identified the need for further research as well as actions around the two concepts. [1] Braesco V, Souchon I, Sauvant P, Haurogné T, Maillot M, Féart C, et al. Ultra-processed foods: How functional is the nova system? European Journal of Clinical Nutrition. 2022;76(9):1245–53. [2] Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. Ultra-processed foods, diet quality, and health using the NOVA classification system [Internet]. Food and Agriculture Association of the United States. 2019 [cited 2023Jan19]. Available from: https://www.fao.org/3/ca5644en/ca5644en.pdf [3] Adherence to government's Eatwell guide key to more sustainable diets [Internet]. British Nutrition Foundation. British Nutrition Foundation; 2021 [cited 2023Jan19]. Available from: https://www.nutrition.org.uk/news/2021/adherence-to-government-s-eatwell-guide-key-to-more- sustainable-diets/ [4] Precision nutrition [Internet]. The Nutrition Source. Harvard University ; 2021 [cited 2023Jan19]. Available from: https://www.hsph.harvard.edu/nutritionsource/precision-nutrition/ [5] de Toro-Martín J, Arsenault B, Després J-P, Vohl M-C. Precision nutrition: A review of Personalized Nutritional Approaches for the prevention and management of Metabolic Syndrome. Nutrients. 2017;9(8):913. Summarised by: Lorna Robertson Revised by: Ela Augustyniak and Sarah Armes (NNEdPro)
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Appointment lengths in primary healthcare should be flexible to accommodate the needs of each individual patient. This allows for personalized care and ensures that patients receive the appropriate amount of time and attention from their clinician. It also allows for more efficient use Implementing digital technologies of clinic time as appointments can such as electronic medical records be scheduled based on the specific and online appointment booking, needs of each patient rather than a can help to streamline the one-size-fits-all approach. Offering appointment process and allow flexible appointment lengths can clinical staff to see more patients improve patient satisfaction and without sacrificing the quality of build trust in the healthcare system. care. It can be challenging for doctors and Finally, when time is limited or other clinical staff to give more time demand for appointments is very to patients and increase high, it may be helpful for doctors appointment lengths when they are to prioritize their patients' needs also required to see more patients and focus on providing the most given the demand for appointments essential care during each and the shortages of key healthcare appointment, rather than trying to workers. address all of a patient's concerns in a single visit. This blog post was written with the help of an AI-engine and the accompanying image created with AI program, Midjourney.
Image created by Javier Gallego via Midjourney
In February the Undergraduate Primary Care Education team and MEdIC welcomed Dr Nav Chana (pictured far right) to the department to lead a seminar on Integrated Care Systems. Dr Chana is a GP, Medical Director and former Chair of the National Association of Primary Care. He has over 25 years of experience of care model redesign with a particular focus on population health and developing sustainable workforce models. The seminar provided greater insight into how integrated care systems are designed, how they have evolved and what they are trying to achieve. This enabled us to explore how our educational courses align with the values and
workings of integrated care systems, how we could best prepare students to work with them in the future and where the research opportunities lie. Dr Chana led us through a journey of understanding the importance of multi- agency collaboration, team-based care and asset-based community development. This prompted discussions about the role of medical education in supporting our future healthcare workforce to develop the attitudes and skills to work within inter-disciplinary teams and to co-create solutions with community partners. In terms of research, there was a call for use of methods that can navigate complexity and ensuring that we are measuring outcomes that matter, rather than those that are easy to record. Dr Chana kindly donated his speaker fee to the Urban Partnership Group
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Much of the discussion about vaccination in the UK is on Covid-19 and flu vaccines or vaccines for children. But there are also other important vaccines for adults – such as for shingles – where there is scope to increase uptake and improve health outcomes for older people and the immunocompromised. Shingles is caused by the people – particularly the elderly reactivation of latent varicella and the immunocompromised – zoster virus (VZV); sometimes shingles can be a very decades after the primary unpleasant illness with chickenpox infection. For some significant complications. In the UK, two vaccines are licensed for shingles: • Zostavax which contains live, attenuated virus and which is given as a single dose. • Shingrix which is a recombinant vaccine and which his given in two doses. The main target group for should receive an invitation for shingles vaccination in the UK is shingles vaccination from their people aged 70-79 years. Most GP. If they didn’t take up the people in this group will receive offer of a vaccination at that the Zostavax vaccine. People in time, they can still get a shingles this age group who are vaccination until they are 79. immunocompromised should Once they turn 80, you will no receive the Shingrix vaccine. The longer be eligible for shingles rationale for vaccinating the vaccination. Shingles is a disease elderly is because complication that has many complications in rates are much higher in this the elderly. It can result in group. For example, hospital considerable pain and discomfort admission rates for shingles and reduce your mobility. In more (zoster) are around 20 times severe cases, it may require higher in people aged 75 and over hospital treatment as an than those aged 15-59. outpatient or inpatient. Vaccination reduces these risks When people turn 70, they substantially.
Driving a Self-Care Revolution in the UK and internationally An important contribution to calls for government to prioritise self-care came with the launch of Sanofi's report ‘Driving a Self-Care Revolution in the UK’ and an excellent panel discussion at the Houses of Parliament. The All-Party Parliamentary Group for Health (APHG) met on Tuesday 31 January 2023 to host a panel discussion to discuss how we can drive a self-care revolution in the UK. This session brought together representatives of the NHS, the Self-Care Academic Research Unit (SCARU) and industry to discuss how joined up working could promote a better understanding of self-care amongst healthcare professionals, patients and the community. The panel also shared insights into making the best use of community pharmacies and to ensuring congruent self-care technologies and services (including over-the-counter (OTC) medication and point of care tests) and services are made available via the right route.
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The panel discussion was chaired by Barry we could build individual self-care capability Sheerman MP (Labour and Co-operative MP across all the seven pillars of self-care for Huddersfield and Policy Connect Co- including health literacy, mental health and founder), and featured the Rt Hon Sir George wellbeing, healthy eating, physical activity, Howarth MP, Sarah Tilsed (Head of Patient good hygiene practices, risk avoidance and Partnership, Patients Association), Harsh GK the rational use of products and services. This (Western Europe Consumer Healthcare Head, education needs also to be person-centred Sanofi), Claire Nevinson (Superintendent and should be relevant to people from all Pharmacist, Boots UK), and Malcolm different walks of life. Self-care education Harrison (Chief Executive, The Company should also be suitable to administer in a Chemists’ Association). variety of settings, including schools, workplaces and social care settings, and not Th panel recognised the need for a National just in the context of patients who need Self-Care Strategy to provide national support. leadership on improving understanding of self-care, encourage its use and relieve the The Self-Care Academic Research Unit burden currently faced by health services. It (SCARU) remains as the only university also identified a need for a realistic overhaul research unit in the world dedicated to the of funding available to pharmacies to be able study of self-care policy and practice and to help release pressures for the NHS, and a remains committed to ‘make the absolute for call for a National Enhanced Pharmacy self-care’ in the UK and internationally. Service, to address the lack of interoperability Interest in self-care has exploded in recent between health care services. This includes years, and particularly since the publication of the need to access shared patient records the first WHO Guideline on Self-Care which would provide a smooth transition of Interventions in 2019. The UK has always care between patients, pharmacists and GPs. been considered as the vanguard for self-care There was also a clarion call for more internationally and it is very exciting for education regarding patient self-care and Imperial SCARU to be part of key self-care greater awareness of the services pharmacies initiatives in collaboration with the Self-Care could provide including for minor ailments. Forum, the International Self-Care Foundation, the Self-Care Trailblazers Group Dr Austen El-Osta, Director of the Self-Care and the Global Self-Care Foundation. You can Academic Research Unit, emphasised that learn more about SCARU’s mission and vision whilst streamlining timely access to OTC statement on the SCARU website or on medicines and technologies is very important, Twitter. OTC products are represented by only one pillar of self-care. Any future self-care strategy in the UK should also take into account how Panel discussion at the Houses of Parliament
FURTHER READING Developing a shared definition of self-driven healthcare Image by Arek Socha from Pixabay
Monkey pox vectors by vecteezy (colours have been altered)
Our recent article in the Journal of the Royal Society of Medicine discusses the diagnosis and management of Monkeypox in UK primary care settings but is also relevant to primary care clinicians working in other countries outside West and Central Africa that have seen Monkeypox cases in 2022.
Skin rash vectors by vecteezy (colours have been altered)
Since its discovery in 1958 declared the current in monkeys, the Monkeypox outbreak a Monkeypox virus has been public health emergency of rarely found outside west international concern, as and central Africa until the the number of cases current global outbreak. increased rapidly around The first human case of the the world. As of 9 virus was in an infant from September 2022, 57,016 the Democratic Republic of cases have been confirmed Congo (DRC) in 1970; the in 96 non-endemic regions, infection has since spread with the UK having one of to other regions, primarily the highest number of cases in Africa. The first case of worldwide (3484 cases). the current outbreak was confirmed on 6 May 2022, As we understand more in the UK and was linked to about the current outbreak, travel to Nigeria. Two particularly the community subsequent UK cases were transmission of the virus, detected a week later; primary care clinicians may however, neither affected be the first point of individuals reported healthcare access. contact with the primary Therefore, awareness of the case in the UK nor travel to signs and symptoms of the Africa. disease and current management strategies is On 23 July 2022, the World crucial to providing optimal Health Organization (WHO) care and advice to patients. Further Reading Human monkeypox: diagnosis and management - BMJ
Spotlight on the research by Imperial College London featured in the latest government report evaluating the digitisation of the NHS Sukriti KC, Dr Anthony Laverty and Dr Felix Greaves, from the PHPE unit, in collaboration with researchers from the University of Oxford have recently contributed to a key report published by the Health and Social Care Committee. The review led by an independent panel of experts assessed the government's progress on digitalising the NHS and rated it as ‘inadequate’, highlighting the urgent need to build stronger digital foundations across the health and social care ecosystems to meet its complex challenges. The research team is supported by NIHR Health and Social Care Delivery Research (HSDR) Programme for developing the evidence base on roll-out and routine use of technology-supported options for health service access, with a focus on the NHS App. Their work highlights potential progress on the digital front and areas in which the NHS App has supported the government’s target to reach its goals, however, the need for further effort and issues surrounding equity concerns were discussed. The parliamentary report heavily drew on the evidence submitted by the research team who were referenced 14 times throughout the report, underscoring the significant impact of their research work and its relevance to policy. Read the published report
Our new article in the Journal of the Royal Society of Medicine examines the impact of vaccination on hospital admissions for Covid-19 in England during 2021. Covid-19 vaccination substantially reduced the risk of hospital admission, particularly in people who received three doses. We used data over a whole calendar year covering multiple variants of SARS-CoV-2, variable case rates and changing vaccine uptake. This provides a population-level the estimates of vaccine overview of the impact of effectiveness. vaccination that is not possible from studies over a shorter We report a dose-dependent period. Using primary diagnosis effect of vaccination, as well as of Covid-19 as the inclusion waning of the effectiveness of criteria increases the specificity each vaccination dose, of our study by excluding those highlighting the value of co-incidentally Covid-19 booster vaccinations. Our positive but admitted for analysis supports an ongoing another reason. We excluded programme of booster “ghost patients” that can bias vaccinations, especially in the elderly and risk groups. FURTHER READING Update for Primary Care Clinical Team 19 January 2023 Factors influencing COVID-19 vaccine hesitancy among South Asians
Woman receiving a vaccine in her arm – Self Magazine – Via Flickr CC BY 2.0
WHY IS FIT IMPORTANT FOR PEOPLE WITH LOWER GASTROINTESTINAL SYMPTOMS? If you consult your doctor about bowel symptoms, they may speak about getting FIT. What is FIT? In this context, it is nothing to do with exercise or how far you can run. FIT stands for faecal immunochemical test, which aims to detect blood in your faeces. The test is highly sensitive. People with lower bowel symptoms such as a change in their bowel habits will understandably be concerned about the possibility of bowel cancer. The risk of colorectal cancer in people with a negative FIT, a normal examination and normal full blood count is <0.1%. This is lower than the general population risk of colorectal cancer. So, this combination of clinical findings allows your doctor to conclude that you are very unlikely to have bowel cancer. However, many people with lower GI symptoms still do not undergo FIT before referral to a specialist. Image by rawpixel.com
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